Association between HIV infection and attenuated diurnal blood pressure rhythm in untreated hypertensive individuals^*

Abstract

ObjectiveHypertensive cardiovascular complications are more closely associated with ambulatory blood pressure (ABP), particularly the attenuated diurnal blood pressure (BP) rhythm (i.e. a fall in systolic blood pressure o10% during the night compared with the day), than with casual BP. The aim of the study was to assess the ABP pattern in an HIV-infected cohort in which hypertension was newly diagnosed. MethodsABP over 24 h was compared between 77 newly diagnosed, untreated hypertensive HIV-positive individuals and 76 HIV-uninfected untreated hypertensive controls. ResultsMore HIV-infected subjects had an attenuated ABP rhythm with a reduced nocturnal fall than HIV-negative hypertensive control subjects (60 vs. 33%, respectively; P 5 0.001). The dipping pattern was observed despite newly diagnosed hypertension, a low prevalence of microalbuminuria, and the absence of signs of overt kidney disease. Furthermore, the prevalence of nondipping in the HIV-infected subjects was independent of combination antiretroviral treatment. Multiple logistic regression analysis with dipping pattern as the dependent variable showed that HIV status was an independent predictor of nondipping BP [P 5 0.002; odds ratio (OR) 0.33; 95% confidence interval (CI) 0.17-0.66]; casual SBP (P 5 0.37; OR 1.001; 95% CI 0.99-1.04) and microalbuminuria (P 5 0.39; OR 1.56; 95% CI 0.57-4.28) were not associated with dipping pattern. ConclusionsThe prevalence of a nondipping BP pattern in HIV-infected subjects with newly diagnosed hypertension who had not received antihypertensive treatment was high and significantly greater than in hypertensive control subjects. IntroductionThe introduction of combination antiretroviral therapy (cART) for HIV-infected patients has altered the prognosis of HIV infection considerably [1] and resulted in a greater diversity of HIV-related causes of death [2]. However, prolonged cART use may have adverse effects [3,4]. Much concern has been raised regarding the increased risk of cardiovascular disease (CVD) in HIV-infected individuals [5], especially when they are treated with protease inhibitors [6][7][8][9]. The cause of progressive vascular damage in HIV-infected patients has not been fully clarified.Hypertension is a major risk factor for CVD in the general population [10]. The prevalence of hypertension in HIV-infected patients varies greatly among populations and ranges from 8 to 34% [8,[11][12][13][14]. Some studies have shown that hypertension is more prevalent among HIV- positive groups than among HIV-negative groups [12,13]. Nevertheless, conflicting results have been obtained in large multicentre studies regarding the putative effect of cART on the development of hypertension [15,16]. Ambulatory blood pressure (ABP) monitoring is increasingly used as a diagnostic tool and for evaluating the effects of essential hypertension treatments [17,18]. Compared with casual blood pressure (BP) measurement, the advantages of ABP measurement include the ability to track BP at night and to monitor circadian BP patterns [...

Ambulatory blood pressure profiles in a subset of HIV-positive patients pre and post antiretroviral therapy : cardiovascular topic

“…A non-dipping pattern is an established entity, with important clinical implications, and is associated with a higher cardiovascular morbidity and mortality rate 31. The high prevalence of non-dippers in the HIV-infected group in this study supports data from Italy and Norway 9,12…”

“…Studies from high-income countries have shown an increased prevalence of non-dipping with HIV infection 9,12. However, the participants in these studies were largely white, middle-aged males.…”

Hypertension and antihypertensive treatment in HIV-infected individuals. A longitudinal cohort study

“…We and others have reported the finding of a higher proportion of patients with nondipping pattern (i.e. reduced nocturnal fall in systolic BP) in HIV-infected subjects with hypertension based on office BP compared to HIV-uninfected hypertensive subjects [94][95][96]. Different studies have reported prevalent hypertension in HIVinfected individuals to be related to HIV-specific factors such as lipodystrophy [79,80,97,98] and higher CD4 cell count [23,97].…”

Mechanisms Influencing Circadian Blood Pressure Patterns Among Individuals with HIV

“…Studies of ABPM in HIV+ individuals have consistently found a high prevalence of non-dipping BP. Two Italian and one Norwegian studies have reported that HIV+ individuals had twice the prevalence of non-dipping BP, compared to HIV− individuals [81][82][83].…”

“…The findings from previous studies of ABPM measures in HIV+ individuals have failed to identify ART as a risk factor for non-dipping BP. For example, a cross-sectional study of HIV+ individuals reported no difference in the prevalence of nondipping BP by ART use [82]. Another study found that non-dipping BP status of HIV+ individuals did not change after 6 months of ART [79].…”